Paternalism is an instance of someone making a decision on behalf of someone else. A professional designer can exhibit paternalism through conceptualizing, defining, and selecting current or preferable situations or while finalizing outcomes for stakeholders. Paternalism is thus, a critical ethical dimension related to the design profession. The design academy and community must theorize paternalism if we are to avoid or reduce it. Paternalism may be present at three critical junctures of design decision making. Our three-layer framework examines paternalism as it relates to design process decisions, decisions about participation in design, and normative framework decisions. The circular model represents the hierarchy of paternalistic decision making: any effort to overcome paternalism at the (inner) design level or (middle) participatory level will be ineffective if it is present in the (outer) normative layer. We discuss the extent of possible exhibitions of paternalism and the challenges to avoiding it in decisions at each layer, and contrast these briefly with overtly paternalistic design approaches, such as design for behavior change. We find that design may be inherently paternalistic, at times may need to be that way (in certain contexts especially, where expertise is required for decisions to be made accurately), and that it is up to the individual designer whether they exhibit paternalism in their design decisions or not.